Chronic Myeloid Leukemia Screening & Diagnosis

Chronic myeloid leukemia (CML) is sometimes found when blood tests are performed for other reasons, so it’s important to tell your doctor about any symptoms you might have.

Detecting and diagnosing CML at the earliest possible point offers patients the most options for treatment and cure.

If you have CML symptoms, the OSUCCC – James experts will conduct a variety of tests, which may include:

Physical Exam

During a physical exam, your doctor will check for signs of CML including swelling in the lymph nodes, spleen or liver. The first physical sign of CML is often an enlarged organ.

Blood Tests

A blood test measures and counts the different types of cells in the blood (patients with CML have too many white blood cells).

Other blood tests may be done to measure the amount of certain chemicals and antibodies (proteins) in the blood. A peripheral blood smear is used to analyze how blood cells look under a microscope.

Bone Marrow Aspiration & Biopsy

Testing the bone marrow will tell how advanced the CML is. During a bone marrow aspiration, your OSUCCC – James specialist will insert a hollow needle into the hipbone or breastbone to remove a small sample of liquid bone marrow.

For a bone marrow biopsy, a hollow needle is inserted into the hipbone to collect a small sample of bone and marrow.

Cellular and Molecular Tests

Your OSUCCC – James subspecialists may use additional tests to detect specific proteins on cell surfaces and to understand other specific features of the cells they have biopsied. Physical changes in the structure of your DNA (called chromosomal rearrangements) can help the experts determine the most effective, targeted treatment for your specific cancer.

Genetic Tests for the Philadelphia Chromosome

Gene testing determines whether or not a patient has the Philadelphia chromosome. This chromosome is found in 95 percent of CML patients, and it causes the body to make too many white blood cells, which in turn become leukemia cells.

Testing for this gene mutation may include:

Cytogenetic Analysis

Cytogenetic analysis identifies defects in the DNA structure (chromosomes) in cells that contribute to developing leukemia.

Identifying these abnormalities can help the OSUCCC – James subspecialists decide the very best kind of personalized treatment for each CML patient.

FISH (Fluorescent in Situ Hybridization)

The FISH analysis is a laboratory test for a patient’s chromosomes. It uses fluorescent dyes to identify tiny parts of the chromosomes that are abnormal. The fluorescent dyes are designed to attach only to certain genes.

RT–PCR Test (Reverse Transcription—Polymerase Chain Reaction Test)

This test analyzes how a tissue sample reacts to certain chemicals, which enables the experts to look for changes in gene structure or function.

Imaging Tests

Imaging tests help your OSUCCC – James experts see pictures of the inside of the body. Detailed images can determine exactly where the disease is and if it may have spread.

Tests may include one of the following:

Computed Tomography (CT) Scans

Use X-rays to capture cross-sectional images of the body.

Magnetic Resonance Imaging (MRI) Scans

Use powerful magnets to capture high-resolution images.

Ultrasound

Use high-energy sound waves and echoes to make a picture of internal organs or tumors. This test is noninvasive and does not use radiation.

Chest X-ray

Painless test that uses electromagnetic waves to create a picture of the inside of your body. Your OSUCCC – James subspecialist will most likely use a chest X-ray for CML to look at your lungs for any signs of infection.

Staging Chronic Myeloid Leukemia

There is no such thing as routine cancer, and chronic myeloid leukemia (CML) behaves differently in each person.

Staging is just one of many ways the OSUCCC – James CML experts plan the most targeted, accurate way to treat your specific cancer. By identifying CML stages (or phases), your CML subspecialists can determine how much of the disease is in your body, whether or not it has spread and if so, where it has spread.

CML staging is based on the number of immature white blood cells (also called blasts or leukemia cells) in the blood and bone marrow and also on how severe the symptoms are. The cancer phase, along with other factors, affects the likely outcome (prognosis).

CML has three phases, and each phase describes CML’s progression based on the number of leukemia cells that are in the blood and bone marrow.

Chronic Phase CML

In this phase, less than 10 percent of the cells in the blood and bone marrow are leukemia cells (also called blasts), and the patient’s symptoms are usually not noticeable.

This is the earliest phase of the disease, and, most of the time, drugs can control the phase, so patients are able to lead normal lives, even after treatment starts.

A small number of patients with chronic phase CML will progress to the accelerated phase.

Accelerated Phase CML

In the accelerated phase, 10 to 19 percent of the cells in the blood and bone marrow are blast cells.

Blast Crisis Phase CML

In this phase, 20 percent or more of the cells in the blood or bone marrow are blast cells, and the number of red blood cells and platelets continues to decrease.

Once CML reaches this advanced phase, the effects are more severe and can be similar to those of acute leukemia. In fact, for one in four patients, the blast crisis phase takes on the appearance of acute lymphoblastic leukemia, while in most other CML patients, it takes on the appearance of acute myeloid leukemia.

If you’ve been diagnosed with chronic myeloid leukemia, would like a second opinion or would like to speak with a leukemia specialist, please call The James Line at 800-293-5066 or 614-293-5066 to make an appointment.